García Fernández Angel, Vagni Roberto, García Andrade Jorge, Flores Mariana, Sentagne Luis, Badiola Francisco
Sanatorio del Salvador, Córdoba, Argentina.
Arch Esp Urol. 2013 Apr;66(3):295-301.
A first experience was carried out in three research centers using a new urethral sling for the treatment of male and female pediatric and young adult population with urinary incontinence caused by neurogenic sphincteric incompetence.
This was a prospective pilot study of patients with neurogenic sphincteric incompetence needing clean intermittent catheterization. All patients were treated by the implantation of Nephis® mini-sling (Promedon, Argentina) over the proximal urethra. Twenty-eight patients were included, 19 females and 9 males. Mean age was 13.4 (SD 7.8 years). The median follow-up was 16.5 (12-24) months. Urodynamic studies were carried out pre and postoperatively to assess the nature of the incontinence and to quantify the outcomes after implantation. A voiding diary was also used to evaluate the Daytime Dryness Intervals between catheterization.
Leak Point Pressure increased from a preoperative mean value of 24.3 cmH2O (SD 6.5) to 51.0 cmH2O (SD14.3) (p<0.0005). The initial mean for Daytime Dryness Interval was 60.4min (SD 9.1) and postoperatively rose to 195.6 (SD 59.4) (p<0.0005). Only one major complication was registered: a sling had to be removed due to erosion in a patient who underwent a concomitant bladder neck reconstruction due to an ectopic ureter repair.
The mini-sling was easy to implant and urodynamic results suggest it is effective in the treatment of neurogenic sphincteric incompetence. This statement is also supported by voiding diary records.
在三个研究中心开展了首次试验，使用一种新型尿道悬带治疗因神经源性括约肌功能不全导致尿失禁的儿科及年轻成人男性和女性患者。
这是一项针对需要清洁间歇性导尿的神经源性括约肌功能不全患者的前瞻性试验研究。所有患者均通过在尿道近端植入Nephis®微型悬带（阿根廷Promedon公司）进行治疗。纳入28例患者，其中女性19例，男性9例。平均年龄为13.4岁（标准差7.8岁）。中位随访时间为16.5（12 - 24）个月。术前和术后均进行尿动力学研究，以评估尿失禁的性质并量化植入后的结果。还使用排尿日记来评估导尿之间的日间干爽间隔时间。
漏点压力从术前的平均24.3 cmH₂O（标准差6.5）增加到51.0 cmH₂O（标准差14.3）（p < 0.0005）。日间干爽间隔时间的初始平均值为60.4分钟（标准差9.1），术后升至195.6（标准差59.4）（p < 0.0005）。仅记录到1例严重并发症：1例因异位输尿管修复同时进行膀胱颈重建的患者，其悬带因侵蚀而不得不移除。
微型悬带易于植入，尿动力学结果表明其在治疗神经源性括约肌功能不全方面有效。排尿日记记录也支持这一结论。
